Just Say Go

Last week the Scottish Executive was under fire when an evaluation of the Know The Score campaign aimed at preventing cocaine use revealed that 12% said they might now try the drug having seen the ads. But a third said they would be deterred while 58% said it didn’t alter the likelihood of them trying the drug. In other words, this didn’t mean that they would snort cocaine, simply that other factors would determine whether they did or not.

Which makes sense because if the benchmark for success is fewer people using drugs, then there is no evidence that mass media campaigns alone have any impact. People choose to use drugs, stop using drugs or not use drugs at all for a whole raft of reasons which have little to do with government advice. Raising awareness and knowledge is achievable, but the Holy Grail is to change behaviour.

This can work where the individuals perceive that failure to follow properly judged advice puts them at immediate risk, especially if those around them have become ill or died. A good example would be the safer sex campaigns aimed at gay men in the 1980s. But when it comes to recreational use of drugs like cannabis, ecstasy, ketamine and so on, this doesn’t appear to work. Why not?

One difference is that the risk is perceived as not immediate – and the same applies to warnings about drinking and smoking aimed at young people. Another is the source of the information – government. At its most extreme, such information can be pure propaganda and nothing more, apart from a fistful of dollars. In 2006, the US Government Accountability Office (GAO) published an evaluation report on the government’s anti-drug campaign conducted between 1998-2004 at a cost of $1.2m. Its stunning but not surprising conclusion was that “the campaign was not effective in reducing youth drug use, either during the entire period of the campaign or during the period from 2002 to 2004 when the campaign was redirected and focused on marijuana use” http://www.gao.gov/docsearch/abstract.php?rptno=GAO-06-818. This was when the Federal government tried to guilt-trip American teenagers into believing that every spliff smoked was another bullet for Al-Qaeda.

Fortunately our government has never been so crass with its efforts to educate the public, although the recent example of the cannabis ‘brain warehouse’ campaign revealed a trend away from the potentially life-saving advice of the rave years, when (Conservative) ministers were signing off on information about harm reduction in the club environment.

Which leads us to the next problem – politics. All government-derived public health campaigns have to be signed off by ministers. And for most part, these are not especially controversial – ‘five a day’, ‘get more exercise’, ‘don’t drink and drive’ and so on. Drugs, of course, are different: trying to walk the tightrope of credible advice without being accused of condoning an illegal activity.

Government can it seems do little to bring down the use of most drugs; the levelling off of ecstasy use (albeit at a high level) is all do with the cycle of drug fashions and wider popular culture, even if politicians are ticking it off in their success box. Therefore relatively little money is spent on specifically public health campaigns about drugs; the bulk of funds are allocated to breaking the link between drugs and crime - and supply-side efforts. It’s the role of FRANK to pick up the slack and cover off the world of recreational drug use. A cocaine campaign is slated for England, although that may well be re-evaluated after the snow-storm which blew down from the North.

So what should government do? It depends on what the requirement is. If the main imperative is political with more sophisticated versions of ‘Just Say No’, then things will carry on as before. If however, the government is serious about providing credible harm-reduction based information on drugs then it could do worse than turn to voluntary sector agencies. If government could bring itself to deliver adequate, but arms-length funding, then there are agencies both at national and local level, maybe acting in concert (rather than fighting over a tender) who could deliver real public health information about drugs.